United States Code
USC most recently checked for updates: Sep 23, 2023
Not later than October 1 of each year, the Office of Personnel Management shall determine the weighted average of the subscription charges that will be in effect during the following contract year with respect to—
enrollments under this chapter for self alone;
enrollments under this chapter for self plus one; and
enrollments under this chapter for self and family.
In determining each weighted average under paragraph (1), the weight to be given to a particular subscription charge shall, with respect to each plan (and option) to which it is to apply, be commensurate with the number of enrollees enrolled in such plan (and option) as of March 31 of the year in which the determination is being made.
For purposes of paragraph (2), the term “enrollee” means any individual who, during the contract year for which the weighted average is to be used under this section, will be eligible for a Government contribution for health benefits.
Except as provided in paragraphs (2), (3), and (4), the biweekly Government contribution for health benefits for an employee or annuitant enrolled in a health benefits plan under this chapter is adjusted to an amount equal to 72 percent of the weighted average under subsection (a)(1)(A) or (B), as applicable. For an employee, the adjustment begins on the first day of the employee’s first pay period of each year. For an annuitant, the adjustment begins on the first day of the first period of each year for which an annuity payment is made.
The biweekly Government contribution for an employee or annuitant enrolled in a plan under this chapter shall not exceed 75 percent of the subscription charge.
In the case of an employee who is occupying a position on a part-time career employment basis (as defined in section 3401(2) of this title), the biweekly Government contribution shall be equal to the percentage which bears the same ratio to the percentage determined under this subsection (without regard to this paragraph) as the average number of hours of such employee’s regularly scheduled workweek bears to the average number of hours in the regularly scheduled workweek of an employee serving in a comparable position on a full-time career basis (as determined under regulations prescribed by the Office).
In the case of persons who are enrolled in a health benefits plan as part of the demonstration project under section 1108 of title 10, the Government contribution shall be subject to the limitation set forth in subsection (i) of that section.
There shall be withheld from the pay of each enrolled employee and (except as provided in subsection (i) of this section) the annuity of each enrolled annuitant and there shall be contributed by the Government, amounts, in the same ratio as the contributions of the employee or annuitant and the Government under subsection (b) of this section, which are necessary for the administrative costs and the reserves provided for by section 8909(b) of this title.
The amount necessary to pay the total charge for enrollment, after the Government contribution is deducted, shall be withheld from the pay of each enrolled employee and (except as provided in subsection (i) of this section) from the annuity of each enrolled annuitant. The withholding for an annuitant shall be the same as that for an employee enrolled in the same health benefits plan and level of benefits.
An employee enrolled in a health benefits plan under this chapter who is placed in a leave without pay status may have his coverage and the coverage of members of his family continued under the plan for not to exceed 1 year under regulations prescribed by the Office.
During each pay period in which an enrollment continues under subparagraph (A)—
employee and Government contributions required by this section shall be paid on a current basis; and
if necessary, the head of the employing agency shall approve advance payment, recoverable in the same manner as under section 5524a(c), of a portion of basic pay sufficient to pay current employee contributions.
Each agency shall establish procedures for accepting direct payments of employee contributions for the purposes of this paragraph.
An employee who enters on approved leave without pay to serve as a full-time officer or employee of an organization composed primarily of employees as defined by section 8901 of this title, within 60 days after entering on that leave without pay, may file with his employing agency an election to continue his health benefits enrollment and arrange to pay currently into the Employees Health Benefits Fund, through his employing agency, both employee and agency contributions from the beginning of leave without pay. The employing agency shall forward the enrollment charges so paid to the Fund. If the employee does not so elect, his enrollment will continue during nonpay status and end as provided by paragraph (1) of this subsection and implementing regulations.
An employing agency may pay both the employee and Government contributions, and any additional administrative expenses otherwise chargeable to the employee, with respect to health care coverage for an employee described in subparagraph (B) and the family of such employee.
An employee referred to in subparagraph (A) is an employee who—
is enrolled in a health benefits plan under this chapter;
is a member of a reserve component of the armed forces;
is called or ordered to active duty in support of a contingency operation (as defined in section 101(a)(13) of title 10);
is placed on leave without pay or separated from service to perform active duty; and
serves on active duty for a period of more than 30 consecutive days.
Notwithstanding the one-year limitation on coverage described in paragraph (1)(A), payment may be made under this paragraph for a period not to exceed 24 months.
The Government contribution, and any additional payments under subsection (e)(3)(A), for health benefits for an employee shall be paid—
in the case of employees generally, from the appropriation or fund which is used to pay the employee;
in the case of an elected official, from an appropriation or fund available for payment of other salaries of the same office or establishment;
in the case of an employee of the legislative branch who is paid by the Chief Administrative Officer of the House of Representatives, from the applicable accounts of the House of Representatives; and
in the case of an employee in a leave without pay status, from the appropriation or fund which would be used to pay the employee if he were in a pay status.
Except as provided in paragraphs (2) and (3), the Government contributions authorized by this section for health benefits for an annuitant shall be paid from annual appropriations which are authorized to be made for that purpose and which may be made available until expended.
The Government contributions authorized by this section for health benefits for an individual who first becomes an annuitant by reason of retirement from employment with the United States Postal Service on or after
July 1, 1971, or for a survivor of such an individual or of an individual who died on or after July 1, 1971, while employed by the United States Postal Service, shall through September 30, 2016, be paid by the United States Postal Service, and thereafter shall be paid first from the Postal Service Retiree Health Benefits Fund up to the amount contained in the Fund, with any remaining amount paid by the United States Postal Service.
In determining any amount for which the Postal Service is liable under this paragraph, the amount of the liability shall be prorated to reflect only that portion of total service which is attributable to civilian service performed (by the former postal employee or by the deceased individual referred to in subparagraph (A), as the case may be) after
June 30, 1971, as estimated by the Office of Personnel Management.
The Government contribution for persons enrolled in a health benefits plan as part of the demonstration project under section 1108 of title 10 shall be paid as provided in subsection (i) of that section.
The Office shall provide for conversion of biweekly rates of contribution specified by this section to rates for employees and annuitants paid on other than a biweekly basis, and for this purpose may provide for the adjustment of the converted rate to the nearest cent.
An annuitant whose annuity is insufficient to cover the withholdings required for enrollment in a particular health benefits plan may enroll (or remain enrolled) in such plan, notwithstanding any other provision of this section, if the annuitant elects, under conditions prescribed by regulations of the Office, to pay currently into the Employees Health Benefits Fund, through the retirement system that administers the annuitant’s health benefits enrollment, an amount equal to the withholdings that would otherwise be required under this section.
(Pub. L. 89–554,
Sept. 6, 1966, 80 Stat. 604; Pub. L. 90–83, § 1(96), Sept. 11, 1967, 81 Stat. 219; Pub. L. 91–418, § 1(a), Sept. 25, 1970, 84 Stat. 869; Pub. L. 93–246, § 1, Jan. 31, 1974, 88 Stat. 3; Pub. L. 94–310, § 3(a), June 15, 1976, 90 Stat. 687; Pub. L. 95–437, § 4(c)(2)(A), Oct. 10, 1978, 92 Stat. 1059; Pub. L. 95–454, title IX, § 906(a)(15), (c)(2)(F), Oct. 13, 1978, 92 Stat. 1226, 1227; Pub. L. 96–54, § 2(a)(53), Aug. 14, 1979, 93 Stat. 384; Pub. L. 99–272, title XV, § 15202(b), Apr. 7, 1986, 100 Stat. 334; Pub. L. 101–239, title IV, § 4003(a), Dec. 19, 1989, 103 Stat. 2135; Pub. L. 101–303, § 1(a), (b), May 29, 1990, 104 Stat. 250; Pub. L. 101–508, title VII, § 7102(a), (b), Nov. 5, 1990, 104 Stat. 1388–333; Pub. L. 102–378, § 2(78), Oct. 2, 1992, 106 Stat. 1355; Pub. L. 104–186, title II, § 215(19), Aug. 20, 1996, 110 Stat. 1747; Pub. L. 104–208, div. A, title I, § 101(f) [title IV, § 422], Sept. 30, 1996, 110 Stat. 3009–314, 3009–343; Pub. L. 105–33, title VII, § 7002(a), Aug. 5, 1997, 111 Stat. 662; Pub. L. 105–261, div. A, title VII, § 721(b)(2), (3), Oct. 17, 1998, 112 Stat. 2065; Pub. L. 107–107, div. A, title V, § 519(a), (b), Dec. 28, 2001, 115 Stat. 1096; Pub. L. 108–375, div. A, title XI, § 1101(b), Oct. 28, 2004, 118 Stat. 2072; Pub. L. 109–435, title VIII, § 803(a)(1)(A), Dec. 20, 2006, 120 Stat. 3251; Pub. L. 113–67, div. A, title VII, § 706(c), Dec. 26, 2013, 127 Stat. 1194.)
cite as: 5 USC 8906